SCENARIOS-U.S. healthcare bill faces uncertain fate

Published:24 Jan 2010 17:25:51 PST

WASHINGTON, Jan 22 - The sweeping healthcare
overhaul pushed by President Barack Obama faces dire prospects
in the U.S. Congress, but Democrats scrambling for a new
approach still hope to salvage at least a scaled-back plan.

Every option under discussion among stunned Democrats
presents its own obstacles and drawbacks, but many worry the
failure to pass any healthcare reform bill would be a huge
political liability in November's congressional elections.

"We have to get a bill passed," House of Representatives
Speaker Nancy Pelosi said on Thursday. "We know that."

The Senate and House already passed separate versions, both
of which would both extend insurance coverage to more than 30
million uninsured Americans, create exchanges where individuals
can shop for insurance plans and bar insurance practices like
refusing coverage to people with preexisting conditions.

But the two chambers still needed to reconcile the
differences between their versions and pass a merged bill again
before it could be sent to Obama to be signed into law.

Those efforts were brought to a quick halt by the upset
election of Massachusetts Republican Scott Brown, an opponent
of the overhaul. His win deprived Democrats of the 60 votes
they need to push a merged healthcare plan through the Senate.

Despite the Democratic proclamations of resolve to pass a
healthcare bill, there is a strong possibility they will not be
able to agree on an approach before this year's elections.

Here is a look at some of the alternatives -- likely and
unlikely -- for a healthcare plan.

THE HOUSE PASSES SENATE BILL UNCHANGED

This was the favored alternative of the White House and
many Senate Democrats, but House Democrats have balked at
swallowing the Senate bill without significant changes. Pelosi
rejected the idea on Thursday.

"In its present form, without any change, I don't think
it's possible to pass the Senate bill in the House," Pelosi
told reporters.

House Democrats are unhappy with Senate provisions like a
tax on high-cost insurance plans, a less restrictive policy on
using federal funds to cover abortions, and full federal
payment in Nebraska for an expansion of Medicaid, the federal
health program for the poor.

CONGRESS PUTS TOGETHER A SCALED-BACK BILL

Some Democrats in the House and Senate have discussed
pulling together some of the more popular and easier to pass
healthcare provisions into a new bill that could win some
Republican support.

Other Democrats have suggested putting many of those same
provisions together in three or four different packages that
could be passed individually or attached to other bills.

The smaller approach could focus on insurance reforms like
federal funding for high-risk pools; prohibiting insurers from
dropping coverage for those who become sick; extending coverage
for children on their parents' plan and repealing the insurance
industry's antitrust exemption.

It also could try to expand coverage through some form of
federal tax credits; extend credits to small businesses to help
them provide health benefits; and offer financial incentives
for states to expand Medicaid.

But putting together a new package would require a careful
culling of the existing 2,000-page bills, which include
numerous interlocking provisions. It also could take more time
than nervous Democrats, worried about November's elections,
want to spend talking about healthcare.

THE USE OF RECONCILIATION PROCESS

Some healthcare changes -- either a stand-alone package or
the House's preferred changes to the Senate bill -- could be
passed through a parliamentary procedure called reconciliation
that requires a simple majority of 51 Senate votes and can be
used only for budget issues.

Democrats so far have shown little appetite for that
approach, which bypasses Republicans and could risk another
political backlash on a bill polls show is already unpopular
with the public.

LET HEALTHCARE DIE FOR THE YEAR

With congressional elections looming, Democrats are anxious
to turn to a debate on job creation and bolstering the economy.
Few want to see another extended battle on a healthcare issue
that they fear has made them targets.